Subutex vs Methadone: Top 12 Differences of Subutex vs Methadone

In this article, I’m going to provide you with an in-depth review of the similarities and differences of Subutex vs methadone. My knowledge and experience on these subjects come from a well-rounded background.

First, I was an opiate addict, and I used both Suboxone (a lot like Subutex) and methadone to get off opiates in the past.

Next, I worked as a counselor at an Opiate Treatment Program (OTP) that specializes in Medication-Assisted Treatment (MAT). If they qualified based on a screening with an Intake Specialist (me), our patients could either be placed on methadone, Subutex, Suboxone, or Vivitrol.

90% of my patients were on either Subutex, Suboxone or methadone, and Medication-Assisted Therapy was my specialty and passion.

Finally, I quit the counseling profession, then went on to become an Opiate Recovery Coach, Blogger, Author, and Speaker…all on the subject of Opiate Detox & Recovery…and I’ve been doing this for over three years now.

You can read my full story here.

Okay…so enough about me.

I simply wanted you to know that I’m not just some writer that studies a topic and then writes an article on it.

I’ve actually lived this, and have been on both sides of the treatment world, as an opiate addict needing help, and as an Opiate Addiction Specialist that helps others.

Coaching and blogging about opiate recovery methods (including Subutex and methadone) is my Life’s Purpose and Mission.

Subutex vs Methadone – Overview

Like I stated in the introduction, in this article, I’ll be covering the similarities and differences of Subutex vs methadone.

Both of these are very effective and proven replacement therapy medications used in the treatment of opioid dependence.

As an Intake Counselor at an OTP, whenever I performed screenings (in person or on the phone), often times I was asked to explain the difference between Subutex and methadone.

Choosing a powerful opioid replacement medication is a BIG decision.

Thus, I took my time with new and potential admits making sure they understood the similarities and differences, as well as the pros and cons of Subutex and methadone.

Subutex Overview

On October 8th, 2002, the FDA announced the approval of Subutex and Suboxone tablets for the treatment of opioid dependence. Subutex and Suboxone also became the first narcotic drugs available for the treatment of opioid dependence that could be prescribed in an office setting under the Drug Addiction Treatment Act (DATA) of 2000.

As a result of these changes in policy, many opiate-dependent individuals were now able to be treated with Subutex and Suboxone.

Some people chose to enroll in OTP’s and received Subutex in an outpatient treatment setting (which includes counseling), while others opted for treatment under the care of a private physician.

All over the nation, people were getting the help they really needed, and for over 15 years now, Subutex and Suboxone have continued to save lives, careers, homes, marriages, families, and much more.

Subutex is a prescription medication containing buprenorphine. Buprenorphine is a controlled substance and semisynthetic opioid derivative of thebaine.

Buprenorphine attaches and binds to the same opioid receptors in the brain and other parts of the body that drugs like heroin, oxycodone, hydrocodone, morphine, and other opioids bind to.

Once it attaches to these receptors, it mimics the effects that opiate drugs produce (though it’s not as powerful).

For this reason, buprenorphine is known as a “partial opioid agonist.”

The other opiate drugs I just mentioned are known as “full opioid agonists,” because they activate the receptors in a stronger and more complete way than buprenorphine. See the illustration below.

Buprenorphine helps opioid-dependent individuals because the daily use of the drug prevents opioid withdrawal symptoms and opioid cravings.

Buprenorphine is very effective at this.

Buprenorphine also acts as an opioid blocker due to its high-binding affinity at the mu-opioid receptors. So if a person takes an opiate while using a therapeutic dose of Subutex, they won’t get high, and likely won’t feel anything.

Methadone Overview

For nearly three decades before the FDA approval of Subutex and Suboxone, methadone hydrochloride (6-dimethylamino-4, 4-diphenyl-3-heptanone hydrochloride) had been the primary means of treating opiate addiction.

Approved by the FDA in 1947 for analgesic and antitussive uses, methadone was shown to be effective in treating opiate addiction in the mid-1960s and was approved by the FDA for this use in late 1972.

Methadone is a full mu-opioid receptor agonist.

Methadone is typically used as a replacement therapy for heroin or other opioid dependence.

Methadone’s slow onset of action when taken orally and long elimination half-life (24–36 hours) allows it to be used as either a maintenance therapy or detoxification agent.

How is Subutex Different from Methadone?

Subutex and methadone are similar because they both contain opioid agonist drugs that can prevent opioid withdrawal symptoms and opioid cravings.

Subutex and methadone are also prescribed for chronic pain, though methadone is more commonly prescribed for this health issue.

But along with some similarities, there are many differences I will now inform you of in regards to the subject of Subutex vs methadone.

Here are the Top 12 differences between Subutex vs methadone…

1. Agonist Effects of Subutex vs Methadone

Methadone is a full opioid agonist. Subutex is a brand name for the drug buprenorphine which is only a partial opioid agonist and is not as powerful as methadone.

2. Formulations of Subutex vs Methadone

Methadone comes as an oral tablet or liquid. Subutex comes as a sublingual tablet.

3. Route of Administration of Subutex vs Methadone

Methadone and Subutex are both taken orally. Methadone tablets and liquid methadone are swallowed. I heard the taste of liquid methadone is so strong it’s hard to make go away.

Subutex tablets are not swallowed. Instead, they are placed under the tongue and used sublingually until the medication dissolves.

4. Qualification Criteria of Subutex vs Methadone

Only people with severe opioid addictions can qualify to receive methadone, while people with less severe addictions can easily get prescribed Subutex.

5. Wait Time for Subutex vs Methadone

If you want to get on methadone, you can schedule an intake at a methadone clinic, use your last opiate before bed, wake up, then go do your intake and get your first dose of methadone. Doctors typically want you to be in at least mild opiate withdrawal, but 12 hours is not so long to wait after your last dose.

For Subutex, there is a danger of going into precipitated withdrawal if you take it when there are still opioids in your system.

Buprenorphine has a high affinity but a low intrinsic value at the mu-opioid receptors.

Thus, if you still have opioids in you and you take Subutex, the buprenorphine will “kick-out” the full agonist and not be able to “activate” the receptors as strongly, creating a precipitated withdrawal syndrome (which is an awful experience).

To be placed on Subutex, most doctors will make a patient wait 24-48 hours or longer after their last dose of a short-acting opioid, and 72 hours or longer after their last dose of a sustained-action opioid. The wait time depends on the half-life of the opioid and how fast the patient metabolizes it.

6. Amount of Freedom of Subutex vs Methadone

Patients taking methadone have to dose daily at the methadone clinic for several months (before they start getting take-homes). But patients can only get take-homes if they maintain clean drug-screens and treatment compliance.

Here are the current regulations for receiving methadone take-home privileges:

Subutex patients have a few options depending on the Subutex provider. Some methadone clinics make you take Subutex daily until they trust you enough to start giving you take homes.

But if you receive a Subutex prescription from a private doctor you get to take the medicine daily from home, after the initial intake and Subutex induction with the doctor.

7. Medication Effects of Subutex vs Methadone

Since Subutex and methadone are both drugs that bind to the mu-opioid receptors, their effects can be similar or identical.

Short-term effects of methadone and Subutex can include the following:

 

The main difference between Subutex and methadone compared to opiates is that they are sustained-release and delayed offset opioids.

The opioid effects come on much slower, then wear off much slower. It’s not a powerful high all at once, then a come-down.

Methadone is much stronger than Subutex, and methadone is the strongest opiate replacement medication there is. A “therapeutic” dose of Subutex or methadone is enough to prevent opioid withdrawal symptoms and cravings. Some people can get high on Subutex and especially on methadone, but they aren’t intended to get a person high.

They are meant to be prescribed in the therapeutic dose range.

But a certain percentage of patients (mostly on methadone) lie to the doctor and say the current dose is not enough to “hold them.”

In this way, they’re able to get dose increases up to a certain point, and thus are able to feel a “high” from Subutex or methadone.

8. Medication Side Effects of Subutex vs Methadone

Both Subutex and methadone can cause some minor and major side effects. Below I’ll list all of them for your convenience.

Methadone major side effects:

 

Methadone minor side effects:

 

Subutex major side effects:

 

Subutex minor side effects:

 

One thing most doctors, patients, and treatment professionals aren’t aware of is that sustained-action opioids (especially methadone) can lead to a disorder called Opioid-Induced Endocrinopathy. It’s one of the most common yet least diagnosed negative consequences of continuous opioid therapy.

If you’re thinking about using Subutex or methadone, or you’re already taking one of them or another opioid, make sure you learn about Opioid-Induced Endocrinopathy signs, symptoms, and treatment by clicking here.

9. Overdose Potential of Subutex vs Methadone

Patients on Subutex and methadone can overdose if they take too much medication, or if they combine the Subutex or methadone with alcohol, benzodiazepines, and certain other drugs that cause respiratory depression.

Subutex has a “ceiling effect.” This means there is a limit (32 mg) to how much it can sedate a person, and taking more and more medication will not result in more opioid effects once the ceiling has been reached.

Methadone is very powerful and much easier to overdose with.

Methadone does not have a ceiling effect.

Symptoms of methadone overdose may include:

 

Symptoms of Subutex overdose may include:

 

10. Price of Treatment of Subutex vs Methadone

Methadone is typically over $200 and less than $400 a month for treatment. Subutex can vary in price much more depending on the doctor or treatment program, the amount of Subutex a person is prescribed, whether or not that person’s insurance covers the medicine, and whether or not the patient uses buprenorphine coupons.

11. The Stigma of Subutex vs Methadone

May opposers of Subutex and methadone claim that patients are “not clean” while taking these medications. Thus, many Subutex and methadone patients will hide the fact that they take an opioid replacement medication.

There is a HUGE stigma associated with being on methadone. There is less of a stigma associated with being on Subutex, but still a stigma.

12. Length of Treatment of Subutex vs Methadone

Methadone treatment can last anywhere from 21 days to many years, decades, or life. Subutex treatment can be as low as a few days, and up to many years or life.

People are typically on methadone for longer durations than Subutex, though not always. I had a small percentage of patients on methadone tell me they were “lifers,” and an even smaller percentage of Subutex patients (1 person in total) tell me they wanted to stay on Subutex forever.

How To Choose Between Subutex and Methadone

I hope you liked my article on Subutex vs methadone. At this point, you may be wondering whether or not you would do better on Subutex or methadone.

Based on my experience working at a methadone clinic, I noticed the patients on methadone typically had more and worse side effects than patients taking Subutex.

Also, many of the patients on methadone continued to use opiates and other drugs even though they were on methadone, while the vast majority of patients taking Subutex were able to stay clean.

Methadone is only for individuals with very severe addictions.

If it were me needing to choose between Subutex and methadone, I would probably get on Subutex first. Then, if it wasn’t strong enough, I would switch over to methadone (so long as I met the qualification criteria).

Subutex and methadone can be wonderful medications when used the right way, however, many people have a difficult time trying to get off Subutex and methadone.

Here are my best articles on how to get Subutex and methadone with the least amount of discomfort:

 

Feel free to bookmark these pages in case you ever need a free, effective detox plan that has helped countless individuals.

If you have any comments or questions on the subject of Subutex vs methadone, please post them in the comment box below. Be safe, and take good care of yourself.

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